Blood Pressure Management in Subarachnoid Hemorrhage: The Role of Blood Pressure Manipulation in Prevention of Rebleeding and the Management of Vasospasm

Abstract

Subarachnoid hemorrhage is a neurological emergency that requires a management strategy different than other stroke types. Morbidity and mortality from subarachnoid hemorrhage is high, and outcomes can be improved with intensive neurological monitoring and management. Avoidance of hypertension is essential in an unsecured, ruptured aneurysm. However, once the aneurysm is secure, hypertensive therapy may need to be employed to avoid the effects of vasospasm. Previous recommendations advocated for Triple-H therapy (consisting of hypertension, hemodilution, and hypervolemia); however, the risks associated with excessive hypervolemia have been shown to outweigh the benefits and consequently, euvolemia is now the recommended management strategy.